CMS Pursues Medicare Deregulation

January 2018

HIDA Government Affairs Update

By Linda Rouse O'Neill
Vice President, Government Affairs

In its first year, the Trump Administration made several key regulatory changes at the Centers for Medicare and Medicaid Services (CMS). These include rolling back the previous administration’s bundled payment program, soliciting feedback on current requirements, and taking steps to reduce the regulatory burden on providers.

These deregulation efforts are detailed in HIDA’s forthcoming Medicare 360° report. Below are some of the key Medicare insights contained in this year’s edition:

Acute Care Market
CMS has launched the Patients Over Paperwork initiative, which calls on providers to offer feedback on regulations, with the aim of reducing the administrative burden on providers.

Post-Acute Market
CMS has requested information from these providers on how the agency can streamline requirements and improve efficiency in each of its proposed rules for post-acute care.

Physician Market
While CMS continues to implement payment changes under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the agency has also taken steps to ease the law’s burdens in 2018. Several industry groups have already raised concerns about the measures doctors must report to CMS.

CMS continues efforts on quality, outcome measures
HIDA expects CMS to continue its efforts to link payments to care quality and outcomes. Here is a look at some of the changes taking effect in 2018:

Acute Care Market
CMS has introduced the Meaningful Measures initiative, which makes quality measures focus more on outcomes, such as 30-day mortality rates for certain conditions, and less on process.

Post-Acute Market
Congress has implemented several policies in recent years, including the IMPACT Act, which provide CMS the tools it needs to make value-based payments to post-acute providers. This measure lays the groundwork for CMS to create a single post-acute payment system.

Physician Market
CMS predicts over 500,000 physicians participated in the Merit-Based Incentive Payment System (MIPS) under MACRA in 2017. The agency encouraged all physicians to report data through this program so they would not risk having their Medicare reimbursement cut.

Other key changes
CMS has taken several steps that are not connected with deregulation or outcomes measurement, but will have a profound effect on large segments of the healthcare industry.
  • The agency has dramatically changed the way it pays for lab services as part of the Protecting Access to Medicare Act of 2014. Specifically, the Clinical Lab Fee Schedule is now based on private payer rates. Under this new system, reimbursements for most lab services will be reduced, and many will receive the maximum 10% cut (CMS cannot cut a test more than 10% in 2018).
  • CMS’s “Emergency Preparedness Requirements For Medicare And Medicaid Participating Providers And Suppliers” aims to ensure adequate planning for disasters and to strengthen coordination between providers and federal agencies. This rule drew particular attention during congressional hearings on 2017 hurricane season response, due to its potential for strengthening emergency preparedness. Distributors can play a key role in helping providers comply with these requirements, which took effect on November 15, 2017.

HIDA’s Medicare 360°: 2018 Medicare Reimbursement Analysis and Outlook features payment details and regulatory outlooks for other care settings as well, including ambulatory surgical centers and home health agencies. HIDA also has a number of other resources to keep you and your customers up-to-date on regulatory and legislative developments. For more information on HIDA reports and resources, email